scholarly journals Portable Dynamic Ultrasonography Versus Fluoroscopy for the Evaluation of Syndesmotic Instability: A Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Noortje Hagemeijer ◽  
Bart Lubberts ◽  
Jirawat Saengsin ◽  
Rohan Bhimani ◽  
Go Sato ◽  
...  
Keyword(s):  
External Rotation ◽  
Intraclass Correlation ◽  
Diagnostic Technique ◽  
P Value ◽  
Proximal Tibiofibular Joint ◽  
Diagnostic Modality ◽  
Interosseous Ligament ◽  
Cadaveric Specimen ◽  
Tibiofibular Ligament ◽  
The Us

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The purpose of this study was to determine the association between tibiofibular clear space (TFCS) values measured with 1) a portable ultrasound (US) device and 2) fluoroscopy during applied external roation stress for the evaluation of syndesmotic instability. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. Portable US device (Butterfly iQ, Butterfly Network Inc) images and fluoroscopic images taken by a mini C-arm were used to evaluate the ankle syndesmosis in the intact stage, and after sequentially sectioning of the anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL) at 7.5Nm torque. A Pearson’s correlation was performed to investigate the correlation between the TFCS among the two modalities. A paired t-test was used to compare TFCS values measured with US or fluoroscopy. Three cadavers were measured by two independent observers to assess reliability of the measurements for each diagnostic modality and analyzed using intraclass correlation coefficients (ICC). P-values of < 0.05 were considered significant. Results: The mean TFCS (+- SD mm) values measured with the US and fluoroscopy are presented in Table 1. TFCS values obtained with the US and fluoroscopy correlated (rho 0.60). Between the imaging modalities similar TFCS values were found in the intact state (difference 0.81+-1.0, p-value 0.061). Compared with fluoroscopy, the TFCS values measured using US increased significantly after sequential transection of the AITFL (0.039), IOL (p=0.004) and PITFL (p<0.001). The ICC for measuring the TFCS with US was 0.86 and 0.84 with fluoroscopy indicating excellent agreement. Conclusion: During application of an external rotation force to the ankle, US and fluoroscopic TFCS measurements among different stages of syndesmotic ligamentous injury correlate. However, compared with fluoroscopy, a portable US ultrasound device seems to be a more sensitive diagnostic technique to evaluate subtle syndesmotic instability. [Table: see text]

scholarly journals Portable Dynamic Ultrasonography is a Useful Tool for the Evaluation of Suspect Syndesmotic Instability: A Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Noortje Hagemeijer ◽  
Rohan Bhimani ◽  
Jirawat Saengsin ◽  
Bart Lubberts ◽  
Gregory R. Waryasz ◽  
...  
Keyword(s):  
Repeated Measures ◽  
External Rotation ◽  
P Value ◽  
Proximal Tibiofibular Joint ◽  
Interosseous Ligament ◽  
Portable Ultrasound ◽  
Cadaveric Specimen ◽  
Ultrasound Device ◽  
Tibiofibular Ligament ◽  
Significant Difference

Category: Ankle; Sports; Trauma Introduction/Purpose: To evaluate syndesmotic instability by measuring the tibiofibular clear space (TFCS) opening using a portable ultrasound device. In addition, we assessed the optimal amount of external rotation torque required to detect syndesmotic instability. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used. Using a portable ultrasound device (Butterfly iQ, Butterfly Network Inc) the ankle syndesmosis was evaluated in the intact stage, and after sequentially sectioning of the anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL)(Figure 1). In each ligamentous sectioning stage TFCS in millimeter (mm) was measured with ultrasound while consecutively 0N, 45N, 60N, 75N, and 90N external rotation directed torque was applied to the ankle. To evaluate which amount of torque would be sufficient to detect syndesmotic instability the delta increase of TFCS opening at different states of torque compared to the unstressed state was calculated. One-way repeated measures ANOVA was used to detect whether an increase in delta-TFCS opening could be detected between the intact state and consecutive syndesmotic ligament transection stages. Correction for multiple comparisons was performed using the Bonferroni-Holm correction. Results: Under all torque-loading conditions TFCS (mean+-SDmm) opening increased as additional syndesmosis ligaments were transected (p-values<0.001). With all ligaments intact an increase of TFCS opening was detected during torque increment, ranging from 4.50+-1.2mm at 0N to 5.7+-1.00mm at 90N. After AITFL transection this amount increased from 5.2+-1.4mm at 0N to 6.5+-1.8mm at 90N. After AITFL+IOL transaction from 6.2+-1.3mm at 0N to 10.6+-6.2mm increase at 90N, and after AITFL+IOL+PITFL transection the TFCS opening increased from 6.8+-1.2mm at 0N to 11.1+-2.8mm at 90N. Significant difference from intact was seen after transection of the IOL, already from the unstressed (0N) state on (difference 3.0+-1.4mm, p-value 0.036). Additionally, the AITF+IOL could also be differentiated from AITFL transection stage at 45N with a difference in TFCS opening of 2.06+-1.2mm (p-value 0.006). Conclusion: Portable dynamic ultrasonography is a useful tool to evaluate suspect syndesmotic instability. TFCS opening increased as additional ligaments of the syndesmosis were transected and application of 45N torque seems to be sufficient to detect syndesmotic instability.

scholarly journals Diagnosing Syndesmosis Instability: Dynamic Ultrasound versus Arthroscopy: A Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Noortje Hagemeijer ◽  
Go Sato ◽  
Rohan Bhimani ◽  
Bart Lubberts ◽  
Mohamed Abdelaziz Elghazy ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Sagittal Plane ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Rank Test ◽  
Proximal Tibiofibular Joint ◽  
Interosseous Ligament ◽  
P Values ◽  
Cadaveric Specimen ◽  
Tibiofibular Ligament

Category: Ankle Introduction/Purpose: To evaluate whether sagittal translation could be detected with ultrasound and arthroscopy and to compare the increasing tibiofibular sagittal translation seen with ultrasound (US) and Arthroscopy. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. The ankle syndesmosis was evaluated using a handheld US device (Butterfly iQ, Butterfly Network Inc, Guilford) and arthroscopy with intact-, and after sequent sectioning of anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior- inferior tibiofibular ligament (PITFL). Sagittal plane translation was simulated with 100N of anterior to posterior (A-to-P) and posterior to anterior (P-to-A) hook force which was applied 5cm above of the ankle joint (Figure 1). Pearson’s correlation, one- way repeated measures ANOVA, and Wilcoxon signed-rank test were used for comparison. Three cadavers were measured by two independent observers to assess reliability and analyzed using intraclass correlation coefficients (ICC). Results: A-to-P translation values obtained with US and Arthroscopy had a correlation of -0.14, and P-to-A translation correlation of 0.44. Using US, intact translation was 0.94+-0.62 with A-to-P hook and 0.87+-0.5 with P-to-A hook. Subsequent A- to-P and P-to-A translation increased with 0.07+-0.96mm and 0.04+-0.76 after AITFL cut, with 0.53+-0.9 and 0.15+-0.5 after IOL cut, and with 0.81+-1.3mm and 0.45+-0.8 after PITFL cut (p-values between 0.122 and 0.270) . Using arthroscopy, intact translation was 0.40 +-0.3 with A-to-P hook and 0.99+-0.5 with P-to-A hook. Subsequent A-to-P and P-to-A translation increased from intact with; 0.001+-0.3 and 0.30+-0.4 after AITFL cut, 0.19+-0.4 and 0.74+-0.7 after IOL cut, and 0.40+-0.5 and 1.1+-0.9 after PITFL cut (p-values between 0.005 and 0.037). No statistical differences between US and Arthroscopy were found. Conclusion: US was unable to differentiate between the different stages of injury, even though a similar increase in translation was seen as compared to arthroscopy. Probably this is due to the high variability seen in the US translation values. As US does have several advantages over arthroscopy; availability, non-invasiveness, low costs, and allowance of using the contralateral side as a direct comparison, this technique should be further explored as a potential diagnostic assessment technique of diagnosing occult syndesmotic instability in the sagittal plane.

scholarly journals Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986401 ◽  
Author(s):  
Stéphanie Lamer ◽  
Jonah Hébert-Davies ◽  
Vincent Dubé ◽  
Stéphane Leduc ◽  
Émilie Sandman ◽  
...  
Keyword(s):  
External Rotation ◽  
Axial Loading ◽  
Interosseous Ligament ◽  
Ankle Motion ◽  
Paired Samples ◽  
Tibiofibular Ligament ◽  
Custom Made ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Careful Management

Background: Syndesmotic injuries can lead to long-term complications; hence, they require careful management. Conservative treatment is adequate when 1 syndesmotic ligament is injured, but surgery is often necessary to achieve articular congruity when 3 syndesmotic ligaments are ruptured. However, there is some controversy over the best treatment for 2-ligament injuries. Purpose: To evaluate the effect of a controlled ankle motion (CAM) walking boot on syndesmotic instability following iatrogenic isolated anterior inferior tibiofibular ligament (AiTFL) injury and combined AiTFL/interosseous ligament (IOL) injuries in a cadaveric simulated weightbearing model. Study Design: Controlled laboratory study. Methods: Ten cadaveric specimens were dissected to expose the tibial plateau and syndesmosis. The specimens were fitted to a custom-made device, and a reproducible axial load of 750 N was applied. Iatrogenic rupture of the syndesmotic ligaments (AiTFL + IOL) was done sequentially. Uninjured syndesmoses, isolated AiTFL rupture, and combined AiTFL/IOL rupture were compared with and without axial loading (AL) and CAM boot. The distal tibiofibular relationship was evaluated using a previously validated computed tomography scan measurement system. Wilcoxon tests for paired samples and nonparametric data were used. Results: The only difference noted in the distal tibiofibular relationship during AL was an increase in the external rotation of the fibula when using the CAM boot. This was observed with AiTFL rupture (8.40° vs 11.17°; P = .009) and combined AiTFL/IOL rupture (8.81° vs 11.97°; P = .005). Conclusion: AL did not cause a significant displacement between the tibia and fibula, even when 2 ligaments were ruptured. However, the CAM boot produced a significant external rotation with 1 or 2 injured ligaments. Clinical Relevance: Further studies are needed to assess the capacity of the CAM walking boot to prevent malreduction when external rotation forces are applied to the ankle. Moreover, special care should be taken during the fitting of the CAM boot to avoid overinflation of the cushions.

Biomechanical Analysis of the Individual Ligament Contributions to Syndesmotic Stability

2016 ◽  
Vol 38 (1) ◽  
pp. 66-75 ◽  
Author(s):  
Thomas O. Clanton ◽  
Brady T. Williams ◽  
Jonathon D. Backus ◽  
Grant J. Dornan ◽  
Daniel J. Liechti ◽  
...  
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Interosseous Membrane ◽  
Matched Pair ◽  
Proximal Tibiofibular Joint ◽  
Tibiofibular Ligament ◽  
Cutting Sequences ◽  
Tibiofibular Joint ◽  
The Individual ◽  
Lateral Ankle Ligaments

Background: Biomechanical data and contributions to ankle joint stability have been previously reported for the individual distal tibiofibular ligaments. These results have not yet been validated based on recent anatomic descriptions or using current biomechanical testing devices. Methods: Eight matched-pair, lower leg specimens were tested using a dynamic, biaxial testing machine. The proximal tibiofibular joint and the medial and lateral ankle ligaments were left intact. After fixation, specimens were preconditioned and then biomechanically tested following sequential cutting of the tibiofibular ligaments to assess the individual ligamentous contributions to syndesmotic stability. Matched paired specimens were randomly divided into 1 of 2 cutting sequences: (1) anterior-to-posterior: intact, anterior inferior tibiofibular ligament (AITFL), interosseous tibiofibular ligament (ITFL), deep posterior inferior tibiofibular ligament (PITFL), superficial PITFL, and complete interosseous membrane; (2) posterior-to-anterior: intact, superficial PITFL, deep PITFL, ITFL, AITFL, and complete interosseous membrane. While under a 750-N axial compressive load, the foot was rotated to 15 degrees of external rotation and 10 degrees of internal rotation for each sectioned state. Torque (Nm), rotational position (degrees), and 3-dimensional data were recorded continuously throughout testing. Results: Testing of the intact ankle syndesmosis under simulated physiologic conditions revealed 4.3 degrees of fibular rotation in the axial plane and 3.3 mm of fibular translation in the sagittal plane. Significant increases in fibular sagittal translation and axial rotation were observed after syndesmotic injury, particularly after sectioning of the AITFL and superficial PITFL. Sequential sectioning of the syndesmotic ligaments resulted in significant reductions in resistance to both internal and external rotation. Isolated injuries to the AITFL resulted in the most substantial reduction of resistance to external rotation (average of 24%). However, resistance to internal rotation was not significantly diminished until the majority of the syndesmotic structures had been sectioned. Conclusion: The ligaments of the syndesmosis provide significant contributions to rotary stability of the distal tibiofibular joint within the physiologic range of motion. Clinical Relevance: This study defined normal motion of the syndesmosis and the biomechanical consequences of injury. The degree of instability was increased with each additional injured structure; however, isolated injuries to the AITFL alone may lead to significant external rotary instability.

Use of Anatomical Landmarks in Ankle Arthroscopy to Determine Accuracy of Syndesmotic Reduction: A Cadaveric Study

2019 ◽  
Vol 13 (3) ◽  
pp. 219-227 ◽  
Author(s):  
Spenser J. Cassinelli ◽  
Thomas G. Harris ◽  
Eric Giza ◽  
Christopher Kreulen ◽  
Lauren M. Matheny ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Ankle Arthroscopy ◽  
Matched Pair ◽  
P Value ◽  
Anatomical Landmarks ◽  
Foot And Ankle ◽  
Tibiofibular Ligament ◽  
Diagnostic Arthroscopy ◽  
Anterior Inferior Tibiofibular Ligament

Background. The aim of this study was to determine the accuracy of ankle arthroscopy as a means for diagnosing syndesmotic reduction or malreduction and to determine anatomical landmarks for diagnosis. Methods. Six matched-pair cadavers (n = 12) with through-knee amputations were studied. Component parts of the syndesmosis and distal 10 cm of the interosseous membrane (IOM) were sectioned in each. The 12 specimens were divided into 2 groups: 6 specimens in the in-situ group fixed with suture button technique and 6 specimens in the malreduced group rigidly held with a 3.5-mm screw. Specimens were randomized to undergo diagnostic arthroscopy by 3 fellowship-trained foot and ankle orthopaedic surgeons in a blinded fashion. Surgeons were asked to determine if the syndesmosis was reduced or malreduced and provide arthroscopic measurements of their findings. Results. Of 36 arthroscopic evaluations, 34 (94%) were correctly diagnosed. Arthroscopic measurement of 3.5 mm diastasis or greater at the anterior aspect of the distal tibiofibular syndesmosis correlated with a posteriorly malreduced fibula. Arthroscopic evaluation of the Anterior inferior tibiofibular ligament (AITFL), IOM, Posterior inferior tibiofibular ligament (PITFL), lateral fibular gutter, and the tibia/fibula relationship were found to be reliable landmarks in determining syndesmotic reduction. An intraclass correlation coefficient (ICC) for interrater reliability of 1.00 was determined for each of these landmarks between 2 surgeons (P < .001). The ICCs between 2 surgeons’ measurements and the computed tomography measurements were found to be 0.896 (P value < .001). Conclusions. Ankle arthroscopy is a reliable method to assess syndesmotic relationship when reduced in situ or posteriorly malreduced 10 mm. Levels of Evidence: Level V: Cadaveric

scholarly journals Validation of the Center-Center Technique for Intraoperative Syndesmosis Fixation Alignment

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Mollie K. Mansfield ◽  
Delaney J. Lagrew ◽  
Anthony A. Pollizzi ◽  
Christopher W. Reb
Keyword(s):  
External Rotation ◽  
Intraclass Correlation ◽  
P Value ◽  
Mean Values ◽  
Computed Tomography Scans ◽  
Value Range ◽  
Center Axis ◽  
The Difference ◽  
Height Increase ◽  
Quantitative Descriptive

Category: Ankle Introduction/Purpose: Distal tibiofibular syndesmosis sprain has been reported among 13% to 23% of all ankle fractures, often requiring surgery. However, post-operative malreduction rates have been reported to range from 0 to 54%. Optimal reduction is a significant predictor of overall functional outcome. The centroids of the tibia and fibula align the theoretically ideal axis of syndesmosis fixation alignment. The “Center-Center” method for syndesmosis fixation is a recently described intraoperative technique for aligning the central axes of the tibia and fibula on the ankle lateral fluoroscopic view, seemingly aligning the centroids. There is a lack of validation and outcomes data to support this technique. This study was performed in order to determine how reliably the ”center-center” technique aligns with the centroid axis of the fibula and tibia. Methods: This was a quantitative descriptive study utilizing 30 axial computed tomography scans from July 1, 2016 to June 30, 2018. Eighteen males and 12 females were included with an average age of 44-years-old. CT measurements were made using Visage 7. Three observers measured the maximum difference in degrees between the Center-Center and Centroid measurements at 10 mm, 20 mm, and 30 mm proximal to the tibial plafond for each patient. The Center-Center axis was established by internally rotating the CT image until the fibula aligned within the center of the tibia. The centroid measurement was established using a tool that calculated the centroid of each bone. Finally, the difference in external rotation required to obtain the Center-Center measurements were observed at levels 10 mm versus 20 mm, 20 mm versus 30 mm, and 10 mm versus 30 mm. Results: The Center-Center and Centroid axes were highly consistent within and between subjects and levels, differing on average by a mean 0.39 degrees (95% CI 0.29 to 0.49 degrees) across all comparisons. These axes externally rotated a mean 3.10 degrees (95% CI 2.56 to 3.64 degrees) from 10 mm to 20 mm and a mean 2.72 degrees (95% CI 2.35 to 3.09 degrees) from 20 mm to 30 mm. There were no statistically significant differences in the mean values obtained between observers for any axis at any height (p-value range 0.4 to 1.0) and intraclass correlation indicated excellent to near perfect interobserver agreement (ICC range, 0.876 to 0.988). Conclusion: The Center-Center technique consistently and closely aligns the fibula and tibia along the Centroid axis. These two axes externally rotate approximately 3 degrees for each 10 mm above the plafond. The Center-Center technique may offer the highly accurate means sought for achieving accurate and consistent intraoperative syndesmosis fixation alignment due to its highly consistent relationship to the Centroid axis. Surgeons should be aware of the external rotation of these axes between heights as the axes externally rotated a mean 3 degrees for each 10 mm height increase. Failure to correct limb rotation for each height could result in iatrogenic malreduction.

Arthroscopic Correlates of Subtle Syndesmotic Injury

2017 ◽  
Vol 38 (5) ◽  
pp. 502-506 ◽  
Author(s):  
Gregory P. Guyton ◽  
Kenneth DeFontes ◽  
Cameron R. Barr ◽  
Brent G. Parks ◽  
Lyn M. Camire
Keyword(s):  
External Rotation ◽  
Objective Measure ◽  
High Likelihood ◽  
Interosseous Ligament ◽  
Intact State ◽  
Spherical Probe ◽  
Tibiofibular Ligament ◽  
Tibiofibular Joint ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Standardized Measurement

Background: Arthroscopic criteria for identifying syndesmotic disruption have been variable and subjective. We aimed to quantify syndesmotic disruption arthroscopically using a standardized measurement device. Methods: Ten cadaveric lower extremity specimens were tested in intact state and after serial sectioning of the syndesmotic structures (anterior inferior tibiofibular ligament [AiTFL], interosseous ligament [IOL], posterior inferior tibiofibular ligament [PiTFL], deltoid). Diagnostic ankle arthroscopy was performed after each sectioning. Manual external rotational stress was applied across the tibiofibular joint. Custom-manufactured spherical balls of increasing diameter mounted on the end of an arthroscopic probe were inserted into the tibiofibular space to determine the degree of diastasis of the tibiofibular joint under each condition. Results: A ball 3 mm in diameter reliably indicated a high likelihood of combined disruption of the AiTFL and IOL. Disruption of the AiTFL alone could not be reliably distinguished from the intact state. Conclusion: Use of a spherical probe placed into the tibiofibular space during manual external rotation of the ankle provided an objective measure of syndesmotic instability. Passage of a 2.5-mm probe indicated some disruption of the syndesmosis, but the test had poor negative predictive value. Passage of a 3.0-mm spherical probe indicated very high likelihood of disruption of both the AiTFL and the IOL. Clinical Relevance: The findings challenge the previously used but unsupported standard of a 2-mm diastasis of the tibiofibular articulation for diagnosis of subtle syndesmotic instability.

Evaluation of a new diagnostic modality for distal assessment of advanced, obstructing hypopharyngeal cancer

2006 ◽  
Vol 121 (4) ◽  
pp. 369-377
Author(s):  
M H Abd El-Monem ◽  
Emad A Magdy
Keyword(s):  
Diagnostic Technique ◽  
Extent Of Resection ◽  
Hypopharyngeal Cancer ◽  
Endoscopic Examination ◽  
Resection Margins ◽  
Diagnostic Modality ◽  
Tumour Extension ◽  
Skip Lesions ◽  
Sensitivity Specificity ◽  
Endoscopic Assessment

Introduction: Pre-operative endoscopic assessment of the distal extension of hypopharyngeal cancer is essential for proper surgical extirpation. This assessment is frequently not feasible in advanced, obstructing tumours.Aims: To study the role of a proposed new diagnostic technique: intra-operative open oesophagoscopy, in distal assessment of advanced hypopharyngeal cancer.Materials and methods: A clinicopathological study, including 35 consecutive patients with obstructing hypopharyngeal cancer.Results: Intra-operative open oesophagoscopy revealed inferior submucosal tumour extension in 19 out of 22 cases proven histopathologically, with a sensitivity, specificity and accuracy of 86, 100 and 91 per cent, respectively. Oesophageal skip lesions were detected in two cases. Intra-operative open oesophagoscopy findings surpassed data obtained from pre-operative radiological investigations and influenced the extent of resection performed. Accordingly, 19 patients had a total laryngopharyngectomy for local disease control, while 16 patients needed an additional total oesophagectomy. Histopathologically negative inferior resection margins were obtained in all cases.Conclusions: Intra-operative open oesophagoscopy was found to be a reliable diagnostic modality for distal assessment of obstructing hypopharyngeal cancer in cases in which pre-operative distal endoscopic examination was not feasible.

Digital Health Engagement in the US Population: Insights From the 2018 Health Information National Trends Survey

2021 ◽  
pp. e1-e4
Author(s):  
Chelsea L. Ratcliff ◽  
Melinda Krakow ◽  
Alexandra Greenberg-Worisek ◽  
Bradford W. Hesse
Keyword(s):  
Public Health ◽  
Health Information ◽  
Health Care Providers ◽  
Digital Health ◽  
Smart Device ◽  
P Value ◽  
Care Providers ◽  
Cross Sectional ◽  
The Us ◽  
National Trends

Objectives. To examine prevalence and predictors of digital health engagement among the US population. Methods. We analyzed nationally representative cross-sectional data on 7 digital health engagement behaviors, as well as demographic and socioeconomic predictors, from the Health Information National Trends Survey (HINTS 5, cycle 2, collected in 2018; n = 2698–3504). We fitted multivariable logistic regression models using weighted survey responses to generate population estimates. Results. Digitally seeking health information (70.14%) was relatively common, whereas using health apps (39.53%) and using a digital device to track health metrics (35.37%) or health goal progress (38.99%) were less common. Digitally communicating with one’s health care providers (35.58%) was moderate, whereas sharing health data with providers (17.20%) and sharing health information on social media (14.02%) were uncommon. Being female, younger than 65 years, a college graduate, and a smart device owner positively predicted several digital health engagement behaviors (odds ratio range = 0.09–4.21; P value range < .001–.03). Conclusions. Many public health goals depend on a digitally engaged populace. These data highlight potential barriers to 7 key digital engagement behaviors that could be targeted for intervention. (Am J Public Health. Published online ahead of print May 20, 2021: e1–e4. https://doi.org/10.2105/AJPH.2021.306282 )

The Relationship Between City “Greenness” and Homicide in the US: Evidence Over a 30-Year Period

2021 ◽  
pp. 001391652110450
Author(s):  
Jonnell C. Sanciangco ◽  
Gregory D. Breetzke ◽  
Zihan Lin ◽  
Yuhao Wang ◽  
Kimberly A. Clevenger ◽  
...  
Keyword(s):  
Violent Crime ◽  
P Value ◽  
Homicide Rates ◽  
Violence Reduction ◽  
Time Period ◽  
The Us ◽  
Longitudinal Effects ◽  
Curve Modeling ◽  
First Time ◽  
Us Cities

Residents in US cities are exposed to high levels of stress and violent crime. At the same time, a number of cities have put forward “greening” efforts which may promote nature’s calming effects and reduce stressful stimuli. Previous research has shown that greening may lower aggressive behaviors and violent crime. In this study we examined, for the first time, the longitudinal effects over a 30-year period of average city greenness on homicide rates across 290 major cities in the US, using multilevel linear growth curve modeling. Overall, homicide rates in US cities decreased over this time-period (52.1–33.5 per 100,000 population) while the average greenness increased slightly (0.41–0.43 NDVI). Change in average city greenness was negatively associated with homicide, controlling for a range of variables (β = −.30, p-value = .02). The results of this study suggest that efforts to increase urban greenness may have small but significant violence-reduction benefits.

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